Nakazawa M, Takao A, Shimizu T, Chon Y
Br Heart J. 1983 May;49(5):461-5. doi: 10.1136/hrt.49.5.461.
The haemodynamic effects of hydralazine were studied in seven infants and a child, each with a large ventricular septal defect. Hydralazine, 0.3 mg/kg, was administered intravenously. This caused a lowering of pulmonary arterial pressure from 57 +/- 4 mmHg to 49 +/- 4 mmHg, and a lowering of left atrial pressure from 12 +/- 1 mmHg to 10 +/- 1 mmHg. Systemic vascular resistance was reduced from 19.0 +/- 2.4 units/m2 to 15.1 +/- 0.9 units/m2. Pulmonary vascular resistance was reduced in six cases and increased in two. Systemic blood flow (Qs) increased in six cases and was unchanged in one. It decreased in one case where the pretreatment Qs was high, that is 6.4 l/min per m2. Pulmonary blood flow (Qp) increased in six cases while it decreased in two. These two cases had a pretreatment Qs less than 3.0 l/min per m2. The pulmonary to systemic blood flow ratio (Qp/Qs ratio) decreased only in three patients who had Qs less than 3.0 l/min per m2 before hydralazine. In contrast, the Qp/Qs ratio increased in the five cases with higher pretreatment Qs. Thus, this study has found that the pretreatment Qs alters the effect of hydralazine on the Qp/Qs ratio in large ventricular septal defects, thus indicating that afterload reduction treatment with hydralazine may be effective in the management of large ventricular septal defects by reducing the Qp/Qs ratio in the cases that are associated with a low systemic blood flow.
研究了7例婴儿和1例儿童使用肼屈嗪的血流动力学效应，这些患儿均患有大型室间隔缺损。静脉注射0.3mg/kg的肼屈嗪。这使得肺动脉压从57±4mmHg降至49±4mmHg，左心房压从12±1mmHg降至10±1mmHg。体循环血管阻力从19.0±2.4单位/m²降至15.1±0.9单位/m²。6例患者的肺血管阻力降低，2例升高。6例患者的体循环血流量（Qs）增加，1例不变。1例预处理时Qs较高（即6.4l/min per m²）的患者其体循环血流量下降。6例患者的肺血流量（Qp）增加，2例下降。这2例患者预处理时Qs小于3.0l/min per m²。仅3例预处理时Qs小于3.0l/min per m²的患者在使用肼屈嗪后肺循环与体循环血流量比值（Qp/Qs比值）下降。相反，预处理时Qs较高的5例患者Qp/Qs比值升高。因此，本研究发现预处理时的Qs改变了肼屈嗪对大型室间隔缺损患者Qp/Qs比值的影响，从而表明在与低体循环血流量相关的病例中，通过降低Qp/Qs比值，使用肼屈嗪降低后负荷治疗大型室间隔缺损可能有效。
